Kathmandu. The passage of a Republican-proposed health bill without renewing ACA funding has created new uncertainty in U.S. health policy.
The Affordable Care Act, or Obamacare, which increases federal health insurance subsidies during the pandemic, is set to expire at the end of this year. However, the Republican health bill passed the US House of Representatives by a vote of 216-211. However, it did not include any provision to extend these grants. For this reason, if Congress doesn’t act quickly, millions of Americans’ health insurance costs are feared to rise significantly at the start of the new year.
The vote is seen as the final major health policy decision in Congress this year. However, just before the vote, differences within the Republican leadership became apparent. Some Republicans, along with Democrats, supported a move to extend Obamacare funding for 3 years. But Republican leadership blocked the initiative with a last-minute procedural decision. The House initially voted 204-203 to block the Democrats’ proposal. There was an uproar in the House of Democrats complaining that they had to forcibly stop the session during the vote.
About 24 million people covered by Obamacare will suffer the biggest blow when the funding ends. Many of them could face higher premiums starting Jan. 1 if Congress doesn’t act. For many, the monthly expenses can add up to the point that they may not be able to afford it. Some may be forced to switch to low-cost plans. While others may be left without health insurance entirely.
Senate Democrat Leader Chuck Schumer has warned that the move could leave millions of Americans without access to health care and burden families with higher deductibles and copayments.
The Republican bill promises some structural changes in the future. But it fails to address the immediate crisis. The bill, when it goes into effect in 2027, could reduce premiums for some people. This could cut federal funding overall. In fact, it can raise premiums for many. It also proposes to expand the scope of union health plans so that small businesses, freelancers and the self-employed can buy group health insurance together.
Republicans argue that creating a separate system in the marketplace would reduce reliance on insurance companies and cost controls. However, critics say this does not guarantee affordable and quality coverage.
An analysis by the nonpartisan Congressional Budget Office reinforces these concerns. According to the organization, if the proposed law is implemented, about 100,000 people could lose health insurance each year by 2035. This would reduce the federal government’s budget deficit by about $35.6 billion. But the question remains: Are these savings justified at the expense of people’s health care?
House Speaker Mike Johnson’s stance in this regard has further complicated the situation. Under House rules, Democrats can ask for a vote to increase the grant. But Johnson has made it clear that he will not schedule a vote on the issue before the first week of January. In his words, this grant is not good policy and he will oppose it. As a result, at the beginning of the new year, the way to avoid financial pressure on the general public is closed.
The issue of health subsidies is already a hot topic in American politics. Previously, the Senate rejected proposed grant plans from both parties, and the issue was one of the reasons for the prolonged government shutdown earlier this year. The 2026 congressional elections are approaching. Notably, Republicans who sided with Democrats in favor of increasing funding were all elected from districts where they could face stiff competition in the next election. This makes the issue of health subsidies more sensitive, taking into account voter pressure and political realities.
Although the bill passes the House, it is not expected to be discussed in the Senate before the end of the year. That means many Americans could face higher health insurance costs as early as January. Still, divisions in the House and concerns from moderate Republicans could pave the way for a new debate in the Senate early in the new year.
Senator Lisa Murkowski, a moderate Republican, has already expressed hope that the House results will be reflected in the Senate in January. The ACA funding crisis has exposed the fundamental complexities of U.S. health policy. On the one hand, there is the pressure to reduce the budget deficit and on the other, there is the responsibility of ensuring affordable health care for millions of people. If Congress doesn’t compromise soon, this policy conflict could quickly escalate into a crisis.
